Posterior selective thoracolumlar or lumbar fusion in adolescent idiopathic scoliosis with Lenke 5C curves

English Keywords:Idiopathic scoliosis  Posterior selective fusion  Surgical indication  Correction level  Intervertebral disc angle

English Abstract:

  【Abstract】 Objectives: To evaluate the outcomes of posterior selective thoracolumbar or lumbar（TL/L） fusion in adolescent idiopathic scoliosis(AIS) with Lenke 5C curves． Methods: 45 consecutive AIS patients(Lenke 5C) undergoing posterior selective TL/L fusion with pedicle screw construction were reviewed． The average follow-up was 36±20 months． Standing anteroposterior, convex side bending and lateral radiographs were measured and analyzed． Results: The average preoperative Cobb angle of TL/L curve was 47.3°±7.2° and corrected to 6.4°±4.6° postoperatively with the correction rate of (84.8±11.6)%, and correction loss was 2.7°±4.6° at the final follow-up. The thoracic curve decreased from 25.7°±7.4° preoperatively to 13.2°±6.7° postoperatively with a spontaneous correction of (48.5±29.4)%, and the correction loss was 1°±6° at the final follow-up. Trunk shift decreased from 21.3±11.5mm preoperatively to 19.5±13.3mm postoperatively, which improved significantly to 10.9±8.9mm at the final follow-up． The tilt of lower instrumented vertebra(LIV) was significantly improved after surgery and well maintained at the final follow-up． The preoperative coronal upper and lower instrumented vertebral disc angle(UIVA and LIVA) improved after surgery and did not deteriorate during the follow-up. Coronal trunk decompensation was found in 3 cases, proximal junctional kyphosis in 1 case, and thoracic decompensation in 1 case which had received revision surgery to extend the fusion level． Conclusions: Posterior selective thoracolumbar or lumbar fusion with pedicle screw construction can obtain satisfactory correction of thoracolumbar or lumbar curve and show spontaneous correction of thoracic curve, while saves mobile segments in adolescent idiopathic scoliosis.